ROUGHLY EDITED COPY
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A National Onsite Two‑in‑One Training Opportunity
CIL‑NET Training
Assisting Individuals to Find Affordable, 
Accessible, Integrated Housing
Renaissance Chicago Downtown Hotel
One West Wacker Drive 
Chicago, Illinois
Tuesday, August 7, 2012
8:50 a.m. ‑ 4:45 p.m.

 

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This text is being provided in a rough draft format.  Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.   
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>> ANN DENTON:  What I want to do ‑‑ what I want to do is give you some very specific, very practical tools that you can use to build the resource map that Pat was talking about.  And so what I was going to do is, I want to show you ‑‑ Lisa asked me, how I do know who's not Shelter Plus Care in my community?  I'm going to show you how to find that, okay?
I've got other question about the public housing authority.  I want to show you how to find your public housing authority plan, which will ‑‑ we found something ‑‑ tell me, sir, your name again.  I've forgotten it.  Peter.  Peter found something in his public housing authority plan when I put it up on the screen that he didn't know about, which is that they had set aside 28 units for people with disabilities.
So I want you to leave this training with these tools.  Troy, let me ask you, since you did this in the online class if you have any wisdom to share coming out of that online class now that I'm interrupting your lunch here.  Sorry.  Did you have to look up your Consolidated Plan, your public housing authority plan, was that useful? 
>> AUDIENCE MEMBER:  For me it was because I'm part of the task force which the city has designated to keep certain entities involved in the Consolidated Plan, what we try and do is get most of our consumers involved so they will know how the monies are being spent.  The problem is that in that Consolidated Plan, they know the language that they use.  They use special needs population.
>> ANN DENTON:  Right, I know. 
>> AUDIENCE MEMBER:  And you have to be careful when you do that because so many people fit into that category.
>> ANN DENTON:  Right. 
>> AUDIENCE MEMBER:  And with the Consolidated Plan, most of the funds from 2008, the HUD, the government gives certain funds, that is for single family homes ‑‑ I'm sorry ‑‑ to landlords and tenants who had large apartments.  They've got a very, very large number of amount of funds to fix up their apartments, but at the same time they didn't include the number of accessible units.
>> ANN DENTON:  Right. 
>> AUDIENCE MEMBER:  And the single family home funds (inaudible) so now the mayor is look at how it's done, so most of the tenants will have homes (inaudible) but the process in our Consolidated Plan needs to be more consumer inclusive.
>> ANN DENTON:  Right. 
>> AUDIENCE MEMBER:  Because if you don't do that, all of a sudden a new development will come in another neighborhood and they're not going to know how, writ came from or if they're qualified in the application process.  So the whole thing about Consolidated Plan it's very convoluted when it comes to getting the consumer involved.
>> ANN DENTON:  Right.  But I think the point that I heard you making in the beginning is that if you know how to find it and you know how to read it, that you can translate that and then people can give better testimony at the public hearings. 
>> AUDIENCE MEMBER:  Then they will know how to better advocate individually and know how to system advocate at the same time.
>> ANN DENTON:  Right, right.  Okay.  Thank you.  Troy.  All right.  So what I want to do is give Pat back this microphone.  And ‑‑ 
>> AUDIENCE MEMBER:  Can I say something about the ConPlan real quick?
>> ANN DENTON:  Please do. 
>> AUDIENCE MEMBER:  When each of you are looking at your community's ‑‑
>> PAT TUCKER:  Microphone. 
>> AUDIENCE MEMBER:  When each of you are looking at your community's Consolidated Plan, there's a piece within that plan that's called the citizen participation plan.  It's a required component of every Consolidated Plan, and that's the jewel you need to find to find out how you can be involved in the development of the Consolidated Plan. 
>> ANN DENTON:  I did.  I'm on.  Okay.  Here's what I want to show you.  First of all, I'm going to talk ‑‑ I want to show you two things in the time we have before we're supposed to resume.  One is I want to show you how to find the answer to the question about Shelter Plus Care.  So Lisa asked me a question about finding her Shelter Plus Care resources.  Those are Shelter Plus Care specific for homeless persons, and so it would be in your Continuum of Care planning process, like Pat explained earlier, you know, they have ‑‑ they sit in buckets.  The funding sits in buckets.  So it's Continuum of Care is the bucket that holds homeless dollars.  Consolidated Plan is a bucket that holds HOME, CDBG, HOPWA, emergency solutions, like we've been talking about.  And then the public housing authority bucket holds housing choice vouchers, Section 8, and it supports public housing authority units and it holds other specialty programs that housing authorities can apply for.  Those are the three big buckets and I want to show you, to answer the question how do you find Shelter Plus Care resources in my continuum, you have to know first of all Shelter Plus Care is homeless, so you look in the homeless bucket.  Here is the Web site for the finding out ‑‑ it's ‑‑ let's see let me find it.  It's the HUD homelessness resource exchange.  And the Web site is www.hudhre.info back slash, okay?
When you get to the HUD HRE Web site and you want to find your resources in your community for homeless people out of the homeless bucket, you go to CoC grantee information.  So it's Continuum of Care awards.  Click on that.  And then you want to know.  In this particular case, for Lisa's community, I wanted to know the most recent year, 2011.  That's the most recent year that they have the report up.  Type of report.  I want to know what the Continuum of Care rewards are.  So I want to know what the money is.
Scope of report.  I want this particular continuum.  So I want her particular continuum in New York state.  Then I select a state.  So I select New York.  And then I select a continuum.  We had to figure out ‑‑ I was looking for Genesee County, and I didn't see that, but we figured out that Orleans County is the continuum that governs three counties.  So on the search engine I have Orleans county search.  And I get my magic.  Dah, dah, dah.  The awards.  This is it.  This is all you've got.
So what you have is ‑‑ these are ‑‑ neither one of these is Shelter Plus Care.  And the ‑‑ neither one of these ‑‑ am I on yet?  Yeah.  Neither one of these is Shelter Plus Care, and the way you can tell is by program type.  This is Supportive Housing Program renewal.  Supportive Housing Program renewal.  If it was shelter care, I can't remember if it's S plus C.  So you ‑‑ so the answer Lisa is that you do not have Shelter Plus Care in your continuum.  That's how you find that out.
Somebody give me another one and I'll find it. 
>> AUDIENCE MEMBER:  Look at Maryland. 
>> AUDIENCE MEMBER:  Actually that's just showing the awards for 2011.
>> ANN DENTON:  That's true. 
>> AUDIENCE MEMBER:  So it may be an ongoing project.
>> ANN DENTON:  That's a great point.  Yes.  There may have been a previous project.  And let's check that right now.  There may have been a previous project that's still running.  It just hasn't been awarded for this year.  So let's check it.
Okay.  So what I'm doing is I'm going back to my search page, and I'm going to change the year.  I'm going to look at 2010.  And now I have to do the whole thing again. 
So that's a good point.  If you want to know everything, you want to look back a little bit because you might have had a program that was defunded, or not renewed.  In this case, that's not the case, because this is exactly the same two grants, it looks like.  So that's what you've got. 
So that's just an example of how to look up Continuum of Care.  Let's look up one of the other buckets.  And this is a different Web site.  So the source Web site that I just used was HUD HRE.  The source Web site that I'm going to now is HUD.gov.  So it's www.HUD.gov.
Okay.  On the Web site, I'm all about practical.  So I don't remember exactly what the address is.  So in the search engine, which is in the upper right‑hand corner of the screen, I'm going to type public housing authority.  And then find your local public housing authority.  And Peter started out asking me questions about a particular person who was objectionable at the public housing authority level in his community, but he wasn't sure if she was the executive director or key staff.  And so the first thing that I did was look up his PHA contact information and make sure that I had it correct, and it's Village of Nyack.  There I found it.  We found it once.  Village of Nyack.  This will take me to an opportunity to give them an e‑mail.  So send them an e‑mail.  That told me that I was in the right place.  So if I want information about what the village of Nyack housing authority is doing, now that I know that they ‑‑ I know their name, and I also know that New York 114, NV 114, if you look at the left‑hand column, that is their HUD number.  That's their HUD designation.  Now you know not only their name, but their number.
Then going back to the search engine, and I want to know what that housing authority is doing.  So I want to look up their plan.  So going back to the search engine, I typed in public housing authority, public housing agency, they're actually agencies, public housing agencies plans.  Click on that.  And then this is where it gets a tiny bit tricky, but it's really not all that hard.  I always want to look at their approved plan.  I don't want to look at something they've submitted ‑‑ there might be a reason to do that, but if I'm just doing research and I want to know what they're doing, I want to look up their approved plan.  So I go to approved plans:  And I know because I've done this once that they don't have an approved plan for 2011.  I looked that up when you guys were eating.  But they do have an approved plan for 2010.  If you were doing this yourself you would just have to hunt and peck.  You would have to find it.  I select the state, which again is New York.
And I know fiscal year beginning 2010.  View approved plans.  Okay.  This tells me all of the approved plans in New York state for that year.  And they are in the second batch.
I swear we had them Peter. 
Nyack village, there they are.  I went right by them.  Okay.  So I found the village which we know from looking a it's ‑‑ its designation was New York 114.  So I have that.  I know that's correct, and that is a validation for me that that's what we're looking for.  Open the PDF file.  It takes a second.
Okay.  And here's is their annual plan.  Now, there's lots of really interesting things in their annual plan.  But one of the things that Peter discovered that he didn't know about, which is great.  That's why you do this.  Is that under 10 additional information, they converted 28 of their tenant based vouchers to project based vouchers in support of a tax credit property for persons with mobility impairments. 
>> AUDIENCE MEMBER: (Inaudible) so instead of having individual vouchers that would travel with the person they converted them to the building and whoever goes into that apartment goes to Section 8?
>> ANN DENTON:  Right.  No, the voucher converted the project base, which means it's now attached to that particular tax credit property.  That's actually, you know, one of the really good things that housing authorities could do, is something like ‑‑ you don't want them to do all of that.  I want to know 28 out of how many.  Because 28 out of 28, that's a problem.  If it's 28 out of 150, that's great.  That's fabulous.
All of this ‑‑ I'm almost done, and then I'm going to let Pat back up.  But I wanted you to not leave without, you know, knowing where to find some of this stuff.  Yes, sir. 
>> AUDIENCE MEMBER:  I just wanted to talk a little bit about what ‑‑ about it might be preferable or not in certain circumstances to convert from a tenant based voucher to a project based voucher, or the other way around.
>> ANN DENTON:  Okay.  That's a great question.  The project ‑‑ housing authorities have the authority from HUD to convert their housing choice voucher to project based.  So the way a housing choice voucher works, it is a tenant based resource, which means that I get ‑‑ I'm one of the lucky ones that counsel on the list.  It's my voucher.  I take it with me.  Not literally, but I carry it around.  I put it ‑‑ you know, I put it to use in a unit that will accept a voucher.  It's mine.  It's attached to me.  When you project base those resources, you're attaching it to a specific project, so a specific ‑‑ and in this case, it's a tax credit project that was built in Nyack, and so they have taken 28 vouchers out of their pool of 236 and they've taken 28 vouchers and attached it to this particular property.  The advantages of doing that are that for the first time you have a tax credit property that's affordable to someone that's on an SSI income.  That's the advantage of doing it, because you have tied it to that particular property.  Tax credits are usually nice.  They're usually well built.  They have a lot of amenities.  So that's a nice thing.  And they're not affordable to people on SSI without some kind of assistance.  They're just not.  They're cheaper than regular housing, but they're not cheap enough for people on SSI.
The disadvantage of project basing is if they took all 236 of their housing choice vouchers and made them all project based, then you would be funneling all individuals who are in poverty who are eligible for housing choice vouch tears a specific number of properties.  And that's not good.  You're constraining choice.  It's not how that program was designed.  Yes, ma'am. 
>> AUDIENCE MEMBER:  Well, if the voucher had not been moved to the project based unit in the first place, couldn't that individual move to the nicer place anyway?
>> ANN DENTON:  Yes, they could. 
>> AUDIENCE MEMBER:  So ‑‑
>> ANN DENTON:  So if I had the voucher in my hot little hand, and I wanted to move to this 28 unit ‑‑ you know, I wanted to move ‑‑ I could move to this complex, yes, I could.  But what it does is it makes, probably, now I know nothing about Nyack, New York, but this kind of thing is usually some kind of an arrangement between the developer ‑‑ a promise from the housing authority to subsidize 28 of their units helps that development's cash flow.
So I know nothing about this particular one, but I would ‑‑ that would be my first supposition more than likely, and there's nothing wrong with that.  There's nothing wrong with that, as long as the 28 vouchers are ‑‑ as long as those 28 units are really being used for people with mobility impairments as it said, and it's not some kind of a dirty trick.
So it depends on your local conditions.  If you have ‑‑ I would never do it if it resulted in segregated housing.  That's my bias, I don't like segregated housing.  But lots of people build segregated units.  We've done it successfully.  There's ways to make the successful.  But if I was the housing authority director, I wouldn't do that.  But what I would do is if I got approached ‑‑ what if you guys want it.  What if Access Living wanted access to a tax credit property, a certain number of tax credit properties?  And the energy from that was coming from the disability community.  Wouldn't that be a good thing to do, project base those units?  Yes, Troy. 
>> AUDIENCE MEMBER:  I don't think that segregated housing is intentional, but you have to look at it from two sides, one the developer is looking to build a multifamily unit, and they're looking (inaudible) the mobility of the tenant.  Those two things are critical.  (inaudible) but historically low income communities have always been in low income neighborhoods.  And with that you're going to (inaudible) you're going to have the same cycle of segregation.  You're going to have the same type of percent population living in those communities.  Economic development is going to occur.  The quality of the schools and the quality of the neighborhood if developers don't extend those communities outside of there.
>> PAT TUCKER:  I agree with that, but I think it really depends on the city.  I know in Chicago they gave out the vouchers when they were doing the ‑‑ you know, getting rid of some of the public housing here.  And a lot of landlords refused to take the vouchers.  So it basically funneled most of the people still into will poor neighborhoods. 
>> AUDIENCE MEMBER:  There's one neighborhood subdivision in Houston, around Houston, they don't want multifamily development in their neighborhood, period.  But at the same time, we're still maintaining that segregated community by tearing down apartments, then those communities are rebuilding in the form of segregated housing.
>> PAT TUCKER:  Right.
>> ANN DENTON:  I think ‑‑ yes, I mean that's a very ‑‑ actually the question of project based versus tenant based runs into all sorts of things, as Troy has pointed out.
I think that you have to make a determination based on local conditions.  So do you want your housing authority to project base some of the units?
There was an example from the state of Georgia probably ten years ago where they took some of the state allocation of public housing authority.  The stand ran a public housing authority and they took some of their allocation and project based it and what they did with it was very creative.  They took 50 vouchers, and what they did with it was they went to people who were on the edge of turnkey.  So they went to people who were developing units through the HOME program or through tax credits, who were right at edge of turnkey and offered them, you know, five or ten units to subsidize five or ten units to guarantee access for people with disabilities into those new properties just opening up.  It's a very creative use of project base.  Yes, ma'am. 
>> AUDIENCE MEMBER:  What does it mean to be on the edge of turnkey?
>> ANN DENTON:  So your project ‑‑ as Pat said earlier, you're either going to do development or you're going to do access to existing housing through vouchers or you're going to do both.  When you're doing development, one of the down sides is it takes forever.  It takes a couple years.  Anybody done development, right?  It takes a couple of years.  So if you have an urgent need for housing you can't wait for development.  On the other hand, lots of communities in this room are rural.  They don't have housing stock.  I could give them a voucher and they could not ‑‑ they might not be able to use it.
So what I mean by on the edge of turnkey is as people were coming through their construction and development process, right before, you know, six months, within three to six months of opening those doors, opening those projects, the state went to some of the ‑‑ went to those people in the pipeline, and I don't remember how they did it exactly.  Was it a request for applications or was it a back room deal, I don't remember.  But they went to them and said we're going to offer project based ‑‑ we're going to offer project based assistance for a ‑‑ it was either five or ten percent of your units in this project ‑‑ you know, up to five percent or ten percent of the units, so that it resulted in integrated housing.  It gave subsidized units to people on a SSI check.  Does that answer the question?  One more thing and then I'm going to stop.  But look at the public housing authority plan, the five‑year and annual plan, I've scrolled back up to the top.  And this is your basic information, this line 2.0.  This tells you what your housing authority got funded for.  And in this case, Nyack county, I can tell you right now, this is a wonderful page.  First of all, they're in the small ‑‑ they're in the small category, which can limit some of the things they can apply for.  They only do housing choice vouchers.  They don't operate their own units.  Do you see that?  That's line 2.0.  Number of PHA units is blank.  Number of Housing Choice Voucher units is 236.  I bet you Peter you didn't know they had 236 vouchers.  I bet you didn't know how many they had. 
>> AUDIENCE MEMBER:  I was told that ‑‑
>> Microphone. 
>> AUDIENCE MEMBER:  I was told that half of the complex pays the normal market rent and the other half is Section 8. 
>> ANN DENTON:  And you're talking about, you had said to me in conversation that these are complexes that they sort of operate.  That's what it looks like to you.  They shouldn't be operating complexes.  You know what I'm saying?  I see a blank over there, so they don't have any public housing authority units.  So that means there's something ‑‑ something that doesn't fit easily into one or both of these categories that they're doing.  It doesn't mean there's anything wrong with what they're doing, but it doesn't cleanly fit.
But the idea about housing choice vouchers is that it doesn't cluster people with low incomes.  One of the things that the housing industry has learned since the days of Cabrini green and I can say that in Chicago.
>> PAT TUCKER:  It was not that far from here.
>> ANN DENTON:  It was not that far from here, and it was a disaster, it was a disaster.  It was high rises where every household in the high rise was at the extreme edges of poverty.  We have learned that the best and healthiest housing development is not about disability.  It's about mixed income, that mixed income and increasingly mixed use in a complex is the healthiest, best cash flowing way to do property development. 
So they may have moved to some kind of a scenario where they're doing a mixed income development, but it's not apparent from this page. 
>> AUDIENCE MEMBER:  Is there anything there that tells you how many units they have in the complex?  Because I don't think they have more than 236 units.
>> ANN DENTON:  They have 236 Housing Choice Voucher units is exactly what it says. 
>> AUDIENCE MEMBER:  That's probably the amount of units that they have in the whole complex.
>> ANN DENTON:  But, see, housing choice vouchers shouldn't be limited to a complex.  And as a matter of fact, the only time you can limit them to a complex is when you change them to project based, which is what they did for 28 of the units down here.  So they have to get permission to take tenant based and turn it into project based. 
>> PAT TUCKER:  We have our public housing expert over there.
>> ANN DENTON:  Yeah.  Yeah, we have a public housing authority ‑‑ am I right? 
>> AUDIENCE MEMBER:  You're right.
>> ANN DENTON:  Good.  Oh, I forgot you were in the room.  It was a moment of anxiety there.
Okay.  So I just ‑‑ you know, because I wanted you to have something that was really practical.  So that's the only reason we're doing that, and now it's time to resume our ‑‑ so I want to take us back to the PowerPoints where you were.  And so let me get out of that.  Here we are.
>> PAT TUCKER:  For all of you that are doing rural housing, the USDA ‑‑ and this actually was a shock to me ‑‑ actually does a lot of money for housing.  So when you're doing your housing resource ma'am, you want to take a look at what the USDA is providing.  So especially if you have rural communities or if you're working in a rural community, you want to see what monies they put out and where that money went to, because they do loans.  They do grants.  They do single family homes, apartments, for low income people and the elderly.  USDA does a lot of housing.  And that was ‑‑ I did not know that.  So you want to look that up.  That's going to be integral to your housing resource map.
Ah.  We've been talking about this.  I've been planning for this and trying to get you ready for it.  But we actually have some of the links for when you're doing your housing resource maps.  Remember, all this information is going to be on Wiki.  I like that name, Wiki.  So you can look this up.  You can just go to the portals and look up information.  And you can go right to your Continuum of Care and to your public housing plans. 
That's our information in case you want to, you know, give us good feedback.  If it's bad feedback, just send it to Ann.
(Laughter.)
>> PAT TUCKER:  Do I have to read this?  This is in there.  That you know.  I'm not going to read it. 
We have a section on housing choice vouchers.  Anybody have to have that, need it?  I see one hand.  One hand.  Going once.  One hand, two hands.  Anybody?  We'll go through it quickly.  How's that? 
>> ANN DENTON:  This is it.  All right.  This is it. 
>> PAT TUCKER:  All right.  Housing choice vouchers.  That actually might be Cabrini Green.  That looks like it.  Cabrini Green wasn't that far away from here.  It actually was prime location.  So I'm not surprised that it is now mixed income, and I think they still have some units available that are low income, if I remember correctly, because they set the standard so high for people to move back in that there were still units available that were low income.  I used to work for CHA a long time ago.
Largest federal affordable housing, that's public choice vouchers, there's over 2.1 million HCVs in the nation.  It's operated by state and local PHAs.  A little background on public housing agencies, created under state law.  Separate entities from the state or local government, but not always.  Sometimes ‑‑ in some places they're not separate.  There's a board that governs everything.  4,000 nationwide HCV programs out there.  And they administer various programs including the Housing Choice Voucher and the public housing.  There are still some communities that don't have a public housing authority.
They are allotted a certain number of housing choice vouchers.  So they don't have completely they can't just come up with a number of housing choice vouchers and say we're going to do that many.  They have a certain amount of money and they provide a certain number of housing choice vouchers.  You have to keep getting more housing choice vouchers.  You can't say we want more.  They don't have control over the number of housing choice vouchers that they have.  It's to provide rental assistance to low income and very low income.  In general the households pay 30 to 40% of their income for rent, which makes it very affordable.
The units have to be in good quality and I always find that funny, because if you looked at some of the units over at Cabrini Green, they wouldn't have passed the inspection, but they are no longer there.  So they're supposed to be in good shape, be able to pass the inspection, housing quality standards inspection. 
This is just a little ‑‑ how the system works.  The program ‑‑ the public housing administration administers the program and establishes the local policies.  Then you have it breaking out to the HCV household, and they issue the vouchers.  So you have the vouchers.  And then you have the vouchers that stay with the building.  You cannot take the housing choice vouchers from the building and take them with you.  Once you leave the building, you leave your Housing Choice Voucher there, your project based.
And your voucher you can take to any landlord that will take your voucher.
>> ANN DENTON:  Tenant based.
>> PAT TUCKER:  The tenant based.  I'm sorry it becomes like this whole thing in my head that ‑‑ and that you can take to any landlord that will take it.  Some landlords don't take them.  And there are a number of reasons why landlords don't take them.
One reason that landlords don't take them is because of how much rent you can collect with them.  It is really based on fair market rent.  Sometimes landlords pay ‑‑ or want more than fire market rent, especially if it's in a nice location or, you know, my property, my two‑bedroom units cost a thousand dollars.  That's how much most of the people in the neighborhood charge for two bedrooms.  Through the tenant based voucher, I was ‑‑ they would only go up to 939 or something like that.  That was how much they were willing to pay for the unit.  So that meant as a landlord I'm losing money, because I can find a person out there to pay a thousand dollars instead of getting $939 from the voucher. 
Also, there are a lot of rules attached to the voucher, a lot of housing inspections that you wouldn't normally have to deal with as a landlord.  And let me just tell you as a landlord ‑‑ and I actually have people in my property who have vouchers ‑‑ it's not fun dealing with the ‑‑ and we've had a long discussion.  And she's actually educated me.  And it goes back to the knowledge.  I work in the system, but when you don't know everything about what you can and cannot say to somebody on the other end, you're at a disadvantages.  And so just having some conversations around what I should have been asking for ‑‑ because I was getting the run around and I should have been asking to speak to a manager, blah, blah, blah, but as a landlord you don't have that time and that energy to put towards that, so why rent to somebody when first of all you're going to lose money and second of all it's going to cost you a lot of time?  So landlords aren't a big fan of the program, but at the same time there's an advantage to it.  And the advantage is you're going to get your rent.  You're at least going to get a portion of your rent every month.  So you know that it's coming.  And so that's the advantage of it.  I'm sure there are some ‑‑ and the other advantage is you're also helping somebody to live in a decent apartment who wouldn't ordinarily find decent housing.  I mean, I have fairly good housing in a good neighborhood that my tenants appreciate having a safe neighborhood that they can live in a decent apartment.
Who makes the rules?  Well, Congress makes the housing laws and appropriates the Housing Choice Voucher funds.  HUD develops the regulations that were not basic framework for the program.  And the PHAs get to establish discretionary policies that address the needs within the public housing jurisdiction.  That's important to know who gets to make the rules, because a lot of times you don't know who makes the rules and you don't realize that because ‑‑ some rules are made at the local public housing authority, and it's important to know that those ‑‑ if they've made the rules, then there are ways to work with them around that rule.  Yes. 
>> AUDIENCE MEMBER:  What if you have a public housing authority or agency that has rules you believe are discriminatory or exclude populations?
>> PAT TUCKER:  Give her that microphone.  The question is:  What if you have a public housing authority that are doing things that you believe are discriminatory? 
>> AUDIENCE MEMBER:  The housing authority, if they have a Web site, they should have information on their Web site as to how to file a discrimination complaint.  But if you think the housing authority is doing things that are discriminatory you need to contact HUD fair housing, whoever is being discriminated against. 
>> AUDIENCE MEMBER:  The design of some of their policies, like we have ‑‑ public housing providers in Vermont they will exclude people because of credit scores and these are people that have been on fixed income for years living in the private sector rental market who obviously they're not going to have good credit scores and then they can't get into subsidized housing because they don't have good credit scores. 
>> AUDIENCE MEMBER:  That's kind of iffy.  If they have a policy that they will conduct ‑‑ pull a credit report and they do that for all of their applicants, that's not really considered discriminatory.  It's just PHA policy.  And some PHAs do have that policy. 
>> PAT TUCKER:  I'm going to go ahead.  I know what you're going to say ‑‑ no, go ahead, Ann. 
>> AUDIENCE MEMBER:  There's actually been a case where I think ‑‑ I know HUD was trying to test this with some regs and Congress kind of shot down those regs.  It was proposed rule that was out.  But it was saying that what landlords were doing without knowingly doing it, they were discriminating against a certain class of people because there were certain ‑‑ a certain population of people that actually could not pass whatever background check the landlord had, and so you were ‑‑ in essence what it was was African‑Americans in this particular area, there was a large percentage that had committed crimes, and so the landlords were running background checks on everybody, but it was the African‑Americans that couldn't pass the background checks, so in essence they were discriminating against this population of people because that was the population of people that couldn't pass the criminal background check.  So I think there was a complaint filed.  I don't know the status of that particular complaint.  That's why it's kind of iffy, I mean when you say they have these discriminatory policies that they were pulling credit scores and you have people that are not meeting those credit scores, I would contact the HUD office any time you think there's some form of discrimination, you should contact the HUD office.
>> ANN DENTON:  I would just add to that, if you don't know this resource, the Bazelon Center for Mental Health Law, so you can Google Bazelon, B‑a‑z‑e‑l‑o‑n.
And they have a lot of information in their housing resource section, and one of the things that they have up there is kind of an analysis of this kind of thing.  And there's very little or no case law yet, but there is ‑‑ there is some interest in looking for a discriminatory effect, which is if I remember right, that's the language that Michael Allen used. 
>> AUDIENCE MEMBER:  I just want to add, it's probably a little gray, but people on fixed incomes, this policy, of credit checks has a disparate impact, and that in and of itself creates the discrimination. 
>> PAT TUCKER: I totally agree with you.  One of the things you might want to look at on an individual basis is the cause of those credit scores, and look at some of the programs for repairing credit, but, yeah, when I worked with the ‑‑ when I worked with CHA that was one of my biggest issues.  The criteria that was set was basically getting rid of a whole chunk of people.  And I felt like it was discriminatory? 
>> AUDIENCE MEMBER:  Well, I will give credit where credit is due.  One of our housing providers has created a financial training program, and they call it a golden ticket.  If you have a bad credit score, you can sign up for this they will rent to you even before you graduate from the course.  But they're one of a dozen.
>> PAT TUCKER:  Well, again, it goes ‑‑ I still would try to still form a relationship with the public housing and still try to work with them to maybe get others to do what this one program is doing.  It wouldn't hurt. 
>> AUDIENCE MEMBER:  Pat, can I add something real quick from HUD?
>> PAT TUCKER:  Sure. 
>> AUDIENCE MEMBER:  I wanted to add that I believe we will be talking about some of these issues that keep coming up about Fair Housing issues on Thursday, Lisa Brennan who works at HUD and she was the Fair Housing counsel in Chicago and now she's in a new position, she's very involved.  She used to work at Access Living.  You can maybe direct some of these questions.  I know she would love to jump into this conversation too, just keep that in mind. 
>> PAT TUCKER:  I told them I was going to pass all the questions on to them.  Yes. 
>> AUDIENCE MEMBER:  Unfortunately, you know, if everybody is subjected to it, it's not discrimination legally, which is a problem, but just because it's not ‑‑ just because it's not discriminatory doesn't mean that it's ‑‑ you know, doesn't mean that it's not bad policy.  So it's important to ‑‑ this could be an opportunity for you to begin to build the relationship with your PHA and begin to have ‑‑ begin have these discussions with them and educate them around these issues and their potential impact and what they might be able to do to help you address them. 
>> PAT TUCKER:  Absolutely.
Public housing, some of the discretionary policies are around establishing waiting lists preferences, people with disabilities, homeless people, veterans, people living or working within the public housing authority jurisdiction.  Also, on the screening.  The criminal activity beyond what HUD requires.  They have some control over that, and housing history.  You are giving me ‑‑ you were looking at me kind of like, really?  Yes, you. 
>> AUDIENCE MEMBER:  So we were having a discussion at our lunch table.  It's my understanding that any ‑‑ any housing entity that receives any kind of federal funds from HUD excludes anybody who has a felony within the last 10 years.  So this is not a federal policy.  This is just something that my PHA has done.
>> PAT TUCKER:  Yes. 
>> AUDIENCE MEMBER:  Yes, that is not a federal policy. 
>> AUDIENCE MEMBER:  Are you able to ‑‑ I mean, I'm sure it's extensive, but are you able to briefly discuss what federally in terms of criminal background ‑‑ 
>> AUDIENCE MEMBER:  Okay.  So briefly, there are two reasons that a housing authority can never assist someone.  That is if they are required to register for life as a sex offender, and if they have been convicted of manufacturing methamphetamine on federally assisted property.  Those are the only two reasons that a housing authority can deny assistance, or must deny assistance permanently to an applicant.
>> ANN DENTON:  That's the only time they can ‑‑ 
>> AUDIENCE MEMBER:  Manufacturing methamphetamine on federally assisted property. 
>> AUDIENCE MEMBER:  Doesn't that also include arson? 
>> AUDIENCE MEMBER:  No, it does not.
>> ANN DENTON:  So you can see from the HUD ‑‑ if you have a housing authority that's saying you can't have had a felony in the last ten years, and they're saying that that's a HUD rule.  It's not a HUD rule, that's a local rule. 
>> AUDIENCE MEMBER:  PHA policy.
>> ANN DENTON:  It's a PHA policy, locally determined.
>> PAT TUCKER:  And that's very important to know, because when you are establishing this relationship, it's important to know what they've come up with, and you might be working with people who didn't come up with, but it's just been the way they've been doing it.  At least you know where it's coming from and that you can actually work with that. 
>> AUDIENCE MEMBER:  Pat.
>> PAT TUCKER:  Yes. 
>> AUDIENCE MEMBER:  Being a legal resident, a citizen, that also included for those in Arizona.
>> PAT TUCKER:  Being a legal citizen, a legal resident. 
>> AUDIENCE MEMBER:  HUD has regulations that state that you can assist ‑‑ they have to be eligible.  An eligible noncitizen in order to receive assistance.  Otherwise you have to pro rate the assistance.  I could go into that, and you will be so confused by the time I'm finished.  I mean, you read the regulations concerning that, and that's why it's really a good idea that they're pointing you to HUD's Web site so you can read some of these regulations for yourselves so when housing authorities are telling you certain things like there's a federal reg, if you've been convicted of a felony, you can't receive assistance, it's ten years, that's not true.  If you go to the HUD regs, you will state that a PHA must deny assistance for these reasons and a PHA may deny for other reasons.  When it says PHA, that's a PHA policy.  And you want to have access to the PHA's administrative plan.  A lot of PHAs have their administrative plan on the Web site.  We happen to be one of them.  So if there's something that your questioning with your hole PHA, ask them for access to their administrative plan.  That lists all of their policies regarding the program. 
>> AUDIENCE MEMBER:  Thank you.
>> PAT TUCKER:  Thank you.  See, that's the woman to ask. 
Other examples.  Payment standard determines the maximum level of subsidy.  Extensions of voucher term for housing search.  Applying for new vouchers. 
More options.  Special housing types.  Project based vouchers.  See, they have a lot of power.  They make it like they don't, like this is just a rule and just live with it.  And we go, okay.  And walk away. 
Reasonable accommodation according to Fair Housing laws, a change in rules, policies, practices or services that may be necessary.  We've talked about this.  I'm not going to go into this again.  But just know, not enough people use the reasonable accommodation.  That's what I find.  I think there's a lot of, should I use it?  Is this a right place to use it?  I always say if it's going to benefit the person, use it. 
Housing Choice Voucher myth busters. 
Are PHAs required to have a waiting list preference?
>> ANN DENTON:  Is this like a quiz?
>> PAT TUCKER:  It sounds like a quiz to me. 
(Audience responds.)
>> PAT TUCKER:  Right.  Are there extra vouchers that HUD can award to PHAs when needed?  That's funny. 
Is it okay to target vouchers to one specific group of people with disabilities such as people with mental illness? 
>> AUDIENCE MEMBER:  Not based on disability, but based on certain (inaudible) don't they ‑‑ sorry.  Don't they segregate vouchers for certain populations, not necessarily based on disability, but based on circumstance, so like a certain percentage then have ‑‑ it kind of goes with the waiting list preferences, percentage goes to this population?
>> ANN DENTON:  There's a lot of ‑‑ there's a lot of guidance.  There's some new guidance related to this that I heard about in a meeting with Medicaid a month ago.  I'm not sure it's out yet.  But as a authority question, the basic answer to this basic question is no.  It's not typically allowed. 
>> AUDIENCE MEMBER:  But they do.  I mean, in our state they have ‑‑ they just issued a hundred vouchers specifically for people with mental illness.  If you don't have mental illness, you're not eligible for those hundred vouchers.  So I mean, whether or not it's HUD or whatever, the local housing provider is doing it.
>> ANN DENTON:  Right.  We didn't mean to open a can of worms.  It's a huge can of worms up at HUD headquarters. 
>> PAT TUCKER:  Yes. 
Thank you. 
>> AUDIENCE MEMBER:  Didn't you say that they are allowed to set waiting list priorities?  Isn't that essentially the same thing? 
>> PAT TUCKER:  Well, waiting list ‑‑ I think for me waiting list is setting aside ‑‑ yes, setting aside a certain number of units for people with a certain disability, that's a waiting list, yes.  So I can see where you're saying it's the same. 
>> ANN DENTON:  I think, if you're interested, you can do some investigation around the HUD Web site, and I can see if I can get a copy of that thing that I heard about a month ago and see if it's out in the public domain yet.  It was guidance to PHAs about this very issue. 
>> AUDIENCE MEMBER:  And I think they might be addressing this on Thursday.
>> PAT TUCKER:  I think we're overlapping, and that's why I'm not going to go into it in great detail, but I think you're going to get more on this than what we're going through today.
Why should someone bother applying for the voucher if the waiting lists are so long?  Uh‑oh.  Okay.  Go. 
>> AUDIENCE MEMBER:  My experience with that is just if somebody is on the waiting list for a really long time, they may have already obtained housing, so sometimes the waiting list moves quite a bit faster than we anticipate that it's going to, or somebody moves and they don't update their information, and they get automatically taken off the list.  That's just my experience.
>> PAT TUCKER:  Uh‑huh.
>> ANN DENTON:  Another reason is when HUD comes out with other sort of programs like the nonelderly disabled for NED vouchers that were issued in 2011, the way that those worked was that a housing authority received them and they had to make them available to people with disabilities on their waiting list first so, if your people are not on their waiting list, they may not get one.
>> PAT TUCKER:  Yes. 
>> AUDIENCE MEMBER:  In one of my counties, they've encouraged us to do it particularly in a city that people, the preference is given to people who already live in that city or work in that city.  So we knew some of our folks would not be eligible.  But they encouraged us to do it because it also gives data as to the number of people out there who need housing and it helps us in our advocacy.
>> PAT TUCKER:  Yes.   
>> AUDIENCE MEMBER:  Yes. I just wanted to mention ‑‑ how I do turn it on?  I did.  I wanted to mention that in Indiana just kind of an aside, the mainstream vouchers, what we found out is that they weren't going ‑‑ they were already set aside for folks with disabilities, but after somebody didn't need it anymore, they weren't going back in as a mainstream voucher, so we were able to go back and identify and get a bunch more vouchers for the state.
>> PAT TUCKER:  Yes, excellent.  Excellent point. 
>> AUDIENCE MEMBER: Pat, can we comment over here?  In front of you.
>> PAT TUCKER:  In front of me.  Yes, sorry. 
>> AUDIENCE MEMBER:  Could I ask the room for anybody's state that is still giving out vouchers?  Raise their hand. 
(Showing of hands.) 
>> AUDIENCE MEMBER:  I think I'm moving to a different state.  This is unbelievable.  I mean, New York has been closed up.  You can't even get a waiting list voucher.  You can't be on waiting list for vouchers in New York state.  That's how bad it is. 
>> AUDIENCE MEMBER:  Sometimes it depends on the city as well.
>> PAT TUCKER:  Is my PHA required to apply for new vouchers when they are available? 
(Audience responds.)
>> PAT TUCKER:  We all wish they were. 
Doesn't my PHA get paid regardless of whether a voucher is used, i.e., leased in a housing unit?
No.  So did you know as much about vouchers as you thought you did?
(Speaking Spanish) there's my Spanish for today.  You're up.
>> ANN DENTON:  Okay.  It's about ten minutes after 2:00.  Is that right?  2:15.  And so what I would like to do ‑‑ I'm sorry.
>> PAT TUCKER:  Uh‑oh, you got the power now.
>> ANN DENTON:  What I would like to do is take a break that's just long enough to switch modules.  So we're going to switch PowerPoints, and then I want to start the conversation about how do we support choice?  We started to have an energetic discussion about that earlier.  We were talking about balancing hope and realism, remember my balance beam.  I want to return us to that topic because I really think that that's sometimes where our housing specialists really struggle.  How I do support choice, which is a good thing, in an environment where there's a thousand years to the waiting list?  So we're going to take about 30 seconds and switch out the PowerPoints.
(Break.) 
>> While you actually have a break, I want to remind you, there will be stacks ‑‑ remember how we have to pay for food, so any more of those little stickies that you want to fill out and put on the table, I will pick up toward the end of the afternoon.  So if you have more questions, more concerns, more positive things, let us know.
>> ANN DENTON:  All right.  Am I on?  Okay.  I'm on.  
So what we're going to do ‑‑ what we're going to do during this session right here is really sort of think about how do we support choice?  And we're going to end right before the break, so I'm warning you, right before the break, we're going to end with you working with the scenario that's in your packet.  So if somebody could look up the page number of that scenario, we're going to look at Kay, who is based on a real person, and we're going to actually think about what ‑‑ how can we ‑‑ how do we look at her ‑‑ actually we're going to look at her strengths and her barriers, okay?
So the thing that I'm always curious about is how do we find ‑‑ how do you find people who want to move out of nursing homes? 
>> AUDIENCE MEMBER:  They find you.
>> ANN DENTON:  They find you, okay. 
>> AUDIENCE MEMBER: (Inaudible.) 
>> ANN DENTON:  At the nursing homes?  Okay.  So develop a relationship with the social workers at the nursing homes.  Yes, ma'am.  Microphone. 
>> AUDIENCE MEMBER:  Our agency has an MFP outreach program where we go into the nursing homes.  That's a team of three folks who go into the nursing home and give presentation.  That's how we do it.
>> ANN DENTON:  Okay.  Any other ideas?  Yes, ma'am. 
>> AUDIENCE MEMBER:  I was going to say our agency has also held workshops for nursing home social workers and administrators, you know, telling them about our different programs.
>> ANN DENTON:  Okay.  Anybody met with any resistance? 
(Chuckles.)
>> ANN DENTON:  Yeah.  So anybody want to talk about that briefly?  Yes, ma'am. 
>> AUDIENCE MEMBER:  When I went to nursing homes where I live to talk to the social workers, there was resistance.  And one of the things that I ran into that was shocking to me, I'm totally new to this, but the nursing home social workers had no clue about Money Follows the Person. 
>> ANN DENTON:  I'm not at all surprised to hear that.  The other thing is I think that there's a built‑in perverse incentive for nursing homes to keep people who are most capable of leaving, right?  And sort of working against that.  Yes, ma'am. 
>> AUDIENCE MEMBER:  I don't understand that only because of the baby boomers, there's going to be such a need if there isn't already, they're always going to be full.
>> ANN DENTON:  Right.  I understand ‑‑ that's logical.  We're not talking logic.  Yes, ma'am. 
>> AUDIENCE MEMBER:  I was going to say, the resistance I got was when I moved out three people who were under VA contract, they had high disability incomes, and like you said, they were more able, and so they were the easy patients, and they were bringing in lots of money, so the nursing home was very upset that I moved those three people out.
>> ANN DENTON:  Yes. 
>> AUDIENCE MEMBER:  And they had told me, they'll never work.
>> ANN DENTON:  Of course, they told you that.  I mean, I'm not saying that all people have evil intent, but they're going to make ‑‑ you know, they're going to make the argument.  I have this hand, and then I'll come to you.  That it's for their own good.  That we want them to stay.  Yes, sir. 
>> AUDIENCE MEMBER:  We have, it's called section Q.  The nursing homes are required every year to ask every resident if they'd like to move back into the community.  The only problem is, they're not required necessarily to report out what they're told.  And they get to decide who is appropriate or not.  Up until this point, and now since Money Follows the Person has started, the state is now going into the nursing home and asking the individuals if they want to move out.  And surprisingly, the nursing homes themselves didn't know there were any resources to move out.  And we've had resources for that effort now for ten years.
>> ANN DENTON:  Right.  Right.  And that could either be purposeful sort of forgetting or it could be genuinely they're focused just inside their little tunnel vision and what they have to do every day.  Yes, ma'am. 
>> AUDIENCE MEMBER:  Is this working?
>> ANN DENTON:  Yeah. 
>> AUDIENCE MEMBER:  We're having an experience right now where the hospital social workers have had these patients for so long that they're saying they're incapable, and they become so protective.  They're blind about what's out there in society.
>> ANN DENTON:  Yes, and so that's not an evil intent.  That's sort of a well meaning intent that says I've known John for ten years, and I don't think he can do this, and so I want to protect him.  Yeah, I'm coming to you. 
>> AUDIENCE MEMBER:  I was just going to say, in maybe ‑‑ it may be different in other states, and I would love to hear if it is.  But the conversation ‑‑ the transition conversation, at least in my experience, tends to consistently leave out folks with developmental disabilities, traditionally focus on the nursing home population and leave the other side of the equation with virtually no resources whatsoever.
>> ANN DENTON:  How many states ‑‑ that's a great point.  How many states define their Olmstead population to include ‑‑ the Olmstead institutional definition to include ICFMRs, anybody?
I know mine does. 
>> AUDIENCE MEMBER:  For example, Utah has a ‑‑ has what ‑‑ our department of health likes to call their state based money follows the person waiver.  And it specifically excludes the IC (inaudible).
>> ANN DENTON:  Right.  I think that there's ‑‑ I think that there is inequities built into the Money Follows the Person program around these kinds of issues.  I know that many, many, many of the states discriminate against people with behavioral health disorders as well.  Discriminate is probably too strong a word.  They're just sort of systematically excluded.
Other questions or comments before we sort of leave the outreach portion? 
>> AUDIENCE MEMBER:  Here.
>> ANN DENTON:  Yes, ma'am.  Oh, Lisa.  I forgot about you. 
>> AUDIENCE MEMBER:  Piggybacking off of the hospital situation, locally there's a lot of communication difficulties between agencies and consumers because the hospitals have to say things in a certain way, and in advocating for those people, hospitals will frequently say well we make this recommendation based on what we expect from them in the hospital.  So I use that in my favor as well.  You can't make a recommendation as to whether or not this individual can be successful at home because you can only do that until they leave your door.
>> ANN DENTON:  Right, right.  There's a logical fallacy there which you can use to your advantage.  Yes.
Okay.  So let's talk about ‑‑ what I want to do is use this session to get you all thinking about strengths‑based assessment, and you may already be experts at that, so I want to hear about it.  But what happens often in our systems, not so much with Centers for Independent Living, but in our systems in general, people are defined by their disability, right?  Would you agree with that statement?  And that things like treatment plans or service plans are based on what people have that is, quote, wrong or it's a deficit, it's almost like a deficit approach.  So what are this person's deficits, and how do we address those deficits?  It's not what are this person's strengths, and how do we lean into those strengths?  So I want to give you an opportunity to think through some of that and remind you that this is how we do it.
Did I see a hand? 
Okay.  So the elements of the strengths‑based approach to practice is you engage the person.  Absolutely the first step.  We talked about it earlier, is I have to have a relationship with you in order to be of service to you.  So you can't do drive‑by assessment, right?  Gentleman just pop in and say, all right, you were in on my list.  Let me get a clipboard, and you said you wanted to move out of the nursing home, so what kind of housing do you want, right?  Or what do you think you could ‑‑ you know, what do you think you would want to do?  Right.  You have to have the time and energy to be able to do some relationship building with people or it will not be successful.
And then assessing for strengths.  How many of you who do this kind of work have ever had to remind somebody that they have strengths?
(Showing of hands.) 
>> ANN DENTON:  Right.  And what do I mean by that?  What do I mean by that? 
>> AUDIENCE MEMBER:  Determination.
>> ANN DENTON:  Huh? 
>> AUDIENCE MEMBER:  I think ‑‑ oops.  I think the folks that we work with are so beat down, and they've heard the negatives for so long that just I think of one of our clubhouse members, her perseverance.  She sees it as nagging, we see it as perseverance.  Not believing the own definitions themselves.  That's sort of what I was fishing for, which is that our systems, not through evil intent, but just the way the systems are structured, because of the focus on pathology or deficits, because of the way that medicate reimbursement is structured ‑‑ Medicaid reimbursement is structured, they end up beating people down.  That's sort of what you said.  People get ‑‑ they almost come to accept ‑‑ sometimes people come to accept or come to believe that they are the disability, and so part of the housing specialist role, I think, is to help ‑‑ is to elicit from people information ‑‑ enough information about them to help them reframe their own experience.  So that was a great example.  You know, I'm a nag versus I'm persistent enough to get what I need.  It's a reframe of the same behavior.
Okay.  So what we look for in terms of strengths ‑‑ and I'm not going to beat this into the ground.  But personal characteristics, so if somebody is friendly versus unfriendly, or somebody is thoughtful and good at analysis rather than, you know, just looking for what is a personal characteristic.  Talents and skills.  I know how to play the piano.  Environmental strengths.  Do I have family?  Do I have culture backing me up?  Do I have community? 
And interests, hopes, and aspirations.  We frequently forget to ask about that.  We forget to ask about that.  It's like, isn't it good enough that I'm helping you get out?  But if you know that somebody really wants to be a politician some day, they want to run for city council, then that helps, doesn't it?  It helps you ‑‑ it helps you frame who they are in a totally different way.  But you don't know that unless you ask.
Okay.  So we also assess for strengths ‑‑ so that was sort of like the personal assessment of what you look for.  This is across domains, and so you look for, you know, when was the ‑‑ my favorite question, and I think I have a slide that says this is:  When was the last time you lived on your own?  What did you like about that?  What were the elements of that time that were the best for you, that worked the best for you?  What ‑‑ you know, what of that would you like to recreate here? 
So that does two things.  One, it gives you information about what their choices are and their preferences, and the other thing it does is it reminds the person that they were successful.  They were successful before at this, whether it's a job, whether it's a living situation.  Sometimes we have to remind people.
Don't forget intimate relationships.  We're about to do a symposium in Oklahoma, actually in Tulsa.  We're part of a symposium, and we're doing a workshop on intimacy, because our systems, you know, we prefer to just think that all the people that we serve, that that's not an issue for them.  But you know what?  If it's going to be important to me as the person moving out of the nursing home, that's one of the things I can't do in a nursing home, is have an intimate relationship with someone.
And spirituality is also something that we frequently overlook.  So keeping all these things in mind, I want you to look at Kay's personal scenario.
>> PAT TUCKER:  Page 89.
>> ANN DENTON:  Page 89.  And if someone who is a good reader would like to read it out loud, I think that would be helpful.  Don't all jump at once. 
>> PAT TUCKER:  I will read it.
>> ANN DENTON:  All right.
>> PAT TUCKER:  Kay is a bright, engaging woman who is a supportive friend and lively member of her local advocacy group.  Born with cerebral palsy, she has difficulty controlling her bodily functions or movements, and people often have trouble understanding her speech.  As a child, she had several surgeries to allow her to sit upright and use a motorized chair.  Now in her 30s, she's had several serious health problems and a decreasing ability to swallow food, resulting in a feeding tube.  Kay lived in a home until she was 18 and then started experimenting with different living situations, including assisted living, a group home, and her own apartment.  When adequate support services can be secured, her own apartment is her preferred choice.  However, there have been some times when service providers have not been totally reliable, and there was one incident where she was left in her chair more than 14 hours because an attendant left her alone and her cell phone battery died.  Despite this experience, Kay has been determined to live by myself and says, I'm willing to take the risk.  About four years ago, Kay had an intestinal blockage requiring surgery, and her recuperation has been hampered by several serious lingering infections.  She had to give up her apartment because she was sick for so long.  For the past 30 months, she has been in a nursing home, and everyone around her assumes she will remain there.  Her mother has developed a chronic illness, and her father cannot provide backup support as he used to when Kay had her own place before.  In the nursing home, she has developed two serious bed sores and is allowed to sit up for just a few hours each day.  Kay has become discouraged and depressed and has considered the possibility that she will never leave the nursing home.  With a flash of her old spirit, Kay put her name on the list of people who wanted to transition out of the facility.  You are her housing specialist.  You go to see her, and she tells you she is not sure about what she wants to do, but she is willing to talk to you about it.
>> ANN DENTON:  All right.  Perfect.
Okay.  So what I would like to do is I would like to have ‑‑ I would love to have you guys break yourselves up into other groups, but I will ‑‑ we won't force choice.  I will leave that to you.  I would like teams of three or four people.  Again sort yourselves out.  Three or four people.  And I would like one person to play the housing specialist.  I would like another person to be Kay.  And then I want the another one or two people to observe, and what I would like you to do, just for about five to seven minutes, is do your first approach to Kay.  Based on what we've talked about, strengths‑based assessments, I want you to in the role play, have a conversation with Kay, you the housing specialist, have a conversation with Kay, and get enough information from her to answer the question:  What are her strengths?  I'd like to hear three.  What are the barriers.  I'd like to hear three.  So you all do.
(Working in groups.) 
>> ANN DENTON:  I'm going to give you all about one more minute, and then I'm going to ask the groups to report out strengths and barriers.
(Working in groups.)
>> ANN DENTON:  Okay.  Are you ready?
30 seconds, people.  30 seconds.
Which tables are done? 
(Showing of hands.)
>> ANN DENTON:  Okay.  This time what I'd like to do ‑‑ first of all, anybody who is actually listening to me, if you would give me a round of applause.
(Applause.)
>> ANN DENTON:  Somebody taught me that years ago, and that's been the best trick.  
Okay.  So this morning when I was doing introductions, I think I ‑‑ or when people were doing introductions, I think I did this table last.  I'd like to offer you the opportunity to go first in terms of identifying ‑‑ I just want to hear strengths first. 
>> AUDIENCE MEMBER:  Do you want all of them or just ‑‑
>> ANN DENTON:  Give me at most two, because ‑‑ because leave me room for the other tables. 
>> AUDIENCE MEMBER:  That's what I'm thinking, yeah. 
>> ANN DENTON:  Give me one actually. 
>> AUDIENCE MEMBER:  I think Kay here, who has a lovely hairdo, we're digging it today, is very good at thinking ahead and imagining what her needs will be, because she's had that experience living independently before.  So she's drawing on the past knowledge. 
>> ANN DENTON:  Anticipating her own needs, okay.  Which table over there would like to go next? 
>> PAT TUCKER:  They can't wait. 
>> ANN DENTON:  Was there a hand?  Right here.  Okay.  You next and then you're next.  All right, Mavis. 
>> AUDIENCE MEMBER:  Kay has ‑‑
>> PAT TUCKER:  Microphone. 
>> AUDIENCE MEMBER:  Kay has identified a good support system, and she's very positive about it.  She feels that her parents are well and that she has siblings, and she's thinking ahead in the sense that before she did not have a backup plan when they are caregiver did not take care of her.
>> AUDIENCE MEMBER: And she also has supportive church members that are also willing to help.
>> ANN DENTON:  Okay.  So church and family.  Okay.  Next table.  A strength.
>> PAT TUCKER:  Don't forget that table over there.
>> ANN DENTON:  I won't.  I won't.  They raised their hands, and I'm coming back to you.  You're next. 
>> AUDIENCE MEMBER:  I'm not sure if it's being repetitive, but we sort of said two things, that she recognizes the quality of care that she needs, because it's changed a good bit since the first time she lived in the community.
>> ANN DENTON:  No, that's different. 
>> AUDIENCE MEMBER:  She was also good at communicating that.
>> ANN DENTON:  So recognizes quality of care, is that what you said? 
>> AUDIENCE MEMBER:  Yeah, the quality of care that she's going to need now.
>> ANN DENTON:  Okay.  Right.  Her needs have changed.  Okay.  This table over in the corner, a strength. 
>> AUDIENCE MEMBER:  A couple that we noticed is she was part of an advocacy group, so she probably has some self‑advocacy skills.
>> ANN DENTON:  Yes. 
>> AUDIENCE MEMBER:  And she seems like a go‑getter.  She was perseverant.
>> ANN DENTON:  So advocacy skills, and then sort of a go‑getter.  Very good.  What else?  Let's see. 
>> PAT TUCKER:  I'm curious.  Did anybody have anything that's not on that list? 
>> ANN DENTON:  Anybody?  Come on.
>> PAT TUCKER:  Right here. 
>> ANN DENTON:  Where is right here? 
>> AUDIENCE MEMBER:  She has the advantage of having had prior experience in an independent setting.
>> ANN DENTON:  Okay.  So she has prior experience independent.  All right.  Yes. 
>> AUDIENCE MEMBER:  Everyone else kind of danced around it, but we said she's self‑determined.  She definitely has the determination to want to move out.
>> ANN DENTON:  Okay.  She's self‑determined.  Okay. 
>> PAT TUCKER:  Any others?  Anything that we're missing so far?  I think this side of the room should do barriers.
>> ANN DENTON:  Okay.  How about those barriers? 
>> PAT TUCKER:  Go ahead. 
>> AUDIENCE MEMBER:  We said she has a high level of medical need. 
>> ANN DENTON:  High level of medical need, okay.
>> PAT TUCKER:  Yes.  She can write fast. 
>> AUDIENCE MEMBER:  If she were to come out of the community, she would have to find a case management agency.  So that could be a great barrier as well.
>> ANN DENTON:  Say that again.  I'm writing it. 
>> AUDIENCE MEMBER:  A safe care plan.
>> ANN DENTON:  A safe care plan, right. 
>> AUDIENCE MEMBER:  Well, the reason why we identified it as a barrier, because her mom was ill, and her father could not be there to support her anymore.  So she's going to be bearing a lot of risk. 
>> ANN DENTON:  Yes, she is bearing some risk there.  And she's not ‑‑ if you read the scenario, she has a history of self‑determination and sort of what they used to call pluck, you know, but she's been beaten down a little bit.  She's less certain. 
>> AUDIENCE MEMBER:  Tying in those two things, she has a communication need.  She has only a cell phone at this point, which was pointed out.  She should have an emergency button and possibly some form of device in case her speech was not good during an emergency.
>> ANN DENTON:  That's thinking ahead.  That's related to the safe care. 
>> PAT TUCKER:  Yes, go ahead. 
>> AUDIENCE MEMBER:  I have two points.  One is that she doesn't have ‑‑ maybe they said it already, family support.  The two that she had, her mother is chronically ill.
>> ANN DENTON:  Right.  Her ability ‑‑ her family's ability to provide her support is reduced. 
>> AUDIENCE MEMBER:  And then the nursing home has beaten her down in the sense that she's been there 30 months, and her belief that she's going to be there the rest of her life, they have that philosophy, I'm sure they're telling her that. 
>> PAT TUCKER:  Any others?  Yes. 
>> AUDIENCE MEMBER:  She doesn't trust her service providers.
>> PAT TUCKER:  Doesn't trust service providers.  Others that we missed.  And this was the table that was having problems coming up with barriers.
>> AUDIENCE MEMBER:  If she had been in the nursing home that long, she may not have any continued therapy.  She may need some sort of supports to be able to increase her strength to be able to live on her own.
>> PAT TUCKER:  Okay.  Others?  Any from that side of the room that we missed?  Yes. 
>> AUDIENCE MEMBER:  Maybe along with that, it sounds like she's not getting mental health support that she needs.  She's going to have to work on depression.  It sounds like she has learned helplessness.
>> PAT TUCKER:  Okay.  Any others?  Okay.
>> ANN DENTON:  All right.  Very good.  All right.  So in the time that we have left before the break, what I really want to direct your attention to is, you did the first piece of what ‑‑ you did the first piece of what needs to happen with someone who wants to leave the facility.  You have done the first piece of that.  You have had the initial conversation.  You've come to understand them a little bit through whatever Kay has been willing to tell you, plus you have what the written record says.  So that's where we are at.
And what I would like to do is, let's talk about how you would do a more thorough sort of, not really an assessment of her needs, but really talk with her at some level of detail about what she might like to do or not do.  So ‑‑ I don't want to fall over the lights here.
Somewhere I lost my clicker.  There it is.
Okay.  So right behind the Kay scenario in your book is the ‑‑ is a form.  This is straight out of the book, Choose, Get, Keep, Integrated Housing that was ‑‑ that's in your binder in the back pocket.  But I want you to look at handout 4B, what do I want in a new place?
This is where we're going with Kay.  And one of the first places to start, as strange as it may seem, what do I like and not like about where I am today?  So let's assume.  We know Kay is in a nursing home.  So my assumption is, you know, having never been in one, my assumption, possibly flawed, is that I would want out of there as fast as ‑‑ as fast as I could possibly go.  Now, I know from talking to people and from talking to the person upon whom Kay is based, it's a much more mixed picture than that.  The nursing home offers some things that Kay considers to be of benefit to her.  So what could those be? 
>> AUDIENCE MEMBER:  Meals.
>> ANN DENTON:  Meals.  What? 
>> AUDIENCE MEMBER:  Consistency of care.
>> ANN DENTON:  Consistency of care. 
>> AUDIENCE MEMBER:  Socialization.
>> ANN DENTON:  Some socialization.  Did I hear socialization? 
>> AUDIENCE MEMBER:  Yes. 
>> AUDIENCE MEMBER:  Medical staff available.
>> ANN DENTON:  Medical staff available.  What else? 
>> PAT TUCKER:  Security.
>> ANN DENTON:  Security. 
>> AUDIENCE MEMBER:  Someone to wash her clothes.
>> ANN DENTON:  Someone to wash her clothes.  Exactly.  And then what would ‑‑ you know, the other thing to ask is:  Why do you ‑‑ you know, what is present in this setting that you want to leave behind?  What is it that you don't want anymore?  What might some of those things be based on Kay?
>> ANN DENTON:  Too many people. 
>> AUDIENCE MEMBER:  Control.
>> ANN DENTON:  Control.  (inaudible) and then times, you know, it's all too common.  What else? 
>> AUDIENCE MEMBER:  Nutrition.
>> ANN DENTON:  Nutrition. 
>> AUDIENCE MEMBER:  Lack of privacy.
>> ANN DENTON:  Lack of privacy.  You want to leave lack of privacy behind. 
>> AUDIENCE MEMBER:  A lack of choices.
>> ANN DENTON:  Lack of choices. 
>> PAT TUCKER:  Loss of personal life or some intimacy.
>> ANN DENTON:  Wants personal ‑‑ 
>> AUDIENCE MEMBER:  Wants her services to be consumer directed instead of ‑‑
>> ANN DENTON:  Yes, services to be consumer directed instead of the other way around.  And one of the essences of this is that people ‑‑ it is the belief and the experience that given the right information, people make good choices for themselves.  And if they don't, we still support their choices until they get more information and make a different choice.
So starting with this gigantic form, one of the things that ‑‑ these are conversation starters.  So another excellent question is if you could only change one thing, what would it be?  Because that really forces her to think about ‑‑ you know, what's the most objectionable piece of this environment?  What do I like the least?  Why do you want to move?  You have to be careful with why questions.  You have to be careful with why questions, because why questions sometimes sound like, why do you want to move?  What are you thinking?  Right?  You have to say, gosh, I'm just wondering, you know, what's motivating you to move?  Or what's going into that?  Why do you have so much energy?
And then finally you want to ask ‑‑ I mean, people ‑‑ how did you come to be in this nursing home or this ICFMR or this state hospital?  How did you come to be here?  Because that gives me as the housing specialist good information.  It may tell me in her records that, like it did in Kay's scenario, that she's here because she has some medical problems, and she had a slow time recovering from them and that she developed complications and that's why she's here.  That may not be Kay's understanding of it at all.  So she may have a completely different understanding.  So getting all that information ‑‑ yeah. 
>> AUDIENCE MEMBER:  I want to go back ‑‑ whoops.  I'll try that.  There, okay.  So I want to go back to the issue that came up a little while ago, because I want to ask if I'm not making mountains out of molehills or not.  And part of it centered around should Kay maybe ask for some counseling because she might be depressed in the current situation that she's in?  Bells go off in my head that say, now Kay is going to have a medical diagnosis for her that says, A, she came in with these issues and now she presents depression as another issue, that then becomes a complication for her as opposed to simply a situational thing, where if you were in the nursing home for 30 months when you really didn't want to be there, you'd be depressed too.  And so to what extent ‑‑ I mean, pardon ‑‑ myself says to me if I identify this the medical side of me is nervous about it.  At the same time I don't want to deny her or create a situation where she may in fact need some nonmedical counseling in order to get over some natural situational depression.  Does that make sense?
>> ANN DENTON:  Yes, it totally makes sense.  I love it.  Because that's a real world question.  If I help her ‑‑ she says, I'm depressed or presents as depressed, you're smart enough to figure that out.  Critically sensitive to figure that out, but the practical thing is if I put that on her paperwork then she's got another diagnosis. 
>> AUDIENCE MEMBER:  It's going to follow her around.   
>> ANN DENTON:  It's going to follow her around.  So the question is what do you do with that?  Of course, there's no one answer.  If you have the clinical skills to identify that without her telling you, then you also ‑‑ you know, you may be able to work an informal solution.  You may want to talk to her about that.  If she says, I'm depressed, say, have you been treated for depression before?  Is that something ‑‑ you know, I would do, because this is the mental health side of me.  I would do a suicide risk assessment.  Any time somebody says they're depressed.  My daughter said to me last night I'm so depressed, and I said ‑‑ 
>> AUDIENCE MEMBER:  Whatever.
>> ANN DENTON:  I should have said that.  I said, well, are you ‑‑ 
>> AUDIENCE MEMBER:  She said, don't even go there, mom.
(Laughter.)
>> ANN DENTON:  She was like, I have this job I hate.  Anyway ‑‑ okay.  So the answer is, you have to use your clinical judgment, and I would bounce that clinical judgment off of my supervisors.  That's what I would do.  And ask Kay what it is that she wants to do, so present in the same way we're talking about making choices about a living situation, say, you know, we can get you the help you need, and it might be that you just need to talk to someone.  It might be that we need to reactivate your membership in the advocacy organization.  It might be that you need medication, that you're suffering from a medical depression.  Because depression, major depression is a brain disease.  It's not about situational aspects.
And so if the only people who need antidepressants are people with that brain disorder, but it may be that had gone previously undiagnosed up until now, and that now she's in this setting where she's slowed down enough, she's noticing that she can't shake it herself.
So you would ‑‑ the short answer is you would need to ask more questions and ask for feedback from your colleagues. 
Okay.  It's time.  I'm getting the hook.
Two more slides and then I think we're done.
Don't forget to ask about how the family or guardian feels about the proposed move.  Do you all deal with people with guardians?
(Audience responds.)
>> ANN DENTON:  And then get contact information.  Right?  These are practical tips for housing specialists, when you are doing that first conversation.  And then when we come back, we're going to look at the self‑assessment form and do a role play.  Yes, ma'am. 
>> AUDIENCE MEMBER:  I'm just concerned going back to the guardian and stuff.  I think that's a touchy subject to me, because she's 30‑some odd years old and she has capacity.
>> ANN DENTON:  Right. 
>> AUDIENCE MEMBER:  I mean, what are you asking the guardian or her family?
>> ANN DENTON:  Right, and in this scenario, Kay does not have a guardian.  But we may run up to people who present just like Kay, who has a lot of strengths, and yet she might have a guardian.  It might be similar to a situation where someone felt a guardianship was appropriate and she wasn't in a position to fight it.  She may be stuck with it historically.  Part of the how is specialist role is to be able to talk to people about that and know ‑‑ and we're not talking about that here, but one of the things that I think a housing specialist needs to know or you need to know within your organization is how to help people who inappropriately have guardians get out of that.
All right.  So let's ‑‑ yes, ma'am.  I have one more hand up.  And then we are going to break. 
>> AUDIENCE MEMBER:  I just wanted to comment on that guardianship piece especially in terms of transitioning, a lot of times families will report themselves as being guardians.  Always, always, always get a copy.
>> ANN DENTON:  Amen.  I like that.  I like that healthy skepticism.  I'm her legal guardian.  Okay.  I'm going to need a copy of that for the file. 
>> AUDIENCE MEMBER:  If somebody does have a guardian, you need their permission to work with them.
>> ANN DENTON:  Yes, you do.  Yes, you do.  And actually in the real world, what would probably have happened you would know that already because the nursing home would have told you that? 
>> AUDIENCE MEMBER:  You have to get a release.
>> ANN DENTON:  And you have to get releases and all that, and then the guardians sometimes try to control where people go.  
All right.  Let's take a break.  Let's take 15 minutes, and we'll see you back here and we're going to do a role play.